Some people might find this article interesting
http://www.theglobeandmail.com/servl...FE26/TPHealth/
What if you did all the right things? Ate better, exercised more, stopped smoking. Would it make any difference? WHO is crunching the numbers, and they look promising. STEPHEN STRAUSS reports
Saturday, February 26, 2005 - Page F7
Two years ago, Liam Devine was on the receiving end of one of those poisonous but truthful remarks that either make you livid or turn you into a lifestyle revolutionary.
The 38-year-old Toronto-based sales representative was in Ottawa lounging around a swimming pool with his extended family. "My older sister said, 'Liam, either get in the pool or put on a shirt.' And I was like, 'Why' and she said, 'You're fat!' " Mr. Devine recounts.
Fat? Could a former gymnast and soccer player have become so obese that even a member of his family couldn't bear to look at him?
Staring at his bulbous, 240-pound reflection, Mr. Devine was forced to agree that his snide sibling was right. He soon embarked on a massive behavioural change that saw him not only exercising for up to two hours in a health club five days a week, but also eating right, drinking only a little and stopping smoking.
He is now a mass of muscle, trimness and body self-satisfaction. "I can bend down and tie my shoe without feeling like I have cut myself in half," he says happily.
Then he recounts all the short-term benefits of the changes: more energy, less illness and an alteration in how young he looks so dramatic that he credits it with getting him a new girlfriend.
But what happens to Mr. Devine and people like him in the long term as they strive to be all they can be? If they do all the right things, with regard to eating, exercising and smoking, will they live longer and healthier lives? Will it make any difference to what they die of and how long and unpleasant that dying will be?
"That's a really good question. People don't die of old age, they die because they are sick," Mr. Devine opines when the question is put to him. "But you know, at 38 years old, I still feel like I am 20, like I am invincible. So I haven't even thought of that."
Mr. Devine is not alone in his ignorance.
While massive campaigns are undertaken to persuade people in the developed world to adopt healthier lifestyles, the effect that better living might have on the population as a whole is just beginning to be studied by scientists in a systematic way. In part, this is because while it is easy to determine how many people are killed in car crashes or by gunshot, how much a heart attack or cancer can be attributed to a bad lifestyle is a extremely difficult thing to calculate accurately.
Michael Wolfson, who is the guru of what is called "attributable fraction" analyses at Statistics Canada, argues that you walk into a numerical minefield when you try to sort out causes from effects. "The fact is, different studies get different results. You do a study in Texas at a fitness clinic and you get different answers from what appears when you look at a cohort in France or Finland, and it is hard to separate out what epidemiologists call confounding factors," he says.
Mr. Wolfson suggests that an example of a confounding factor might be the different health benefits that might accrue depending on the reason for a weight loss: Increasing physical activity, and thus strengthening your heart, might lead to a different life ending than simply decreasing your food intake.
Worse, various advocates of the need for a lifestyle change often come up with death-reduction figures that are overblown because "there usually is an axe to grind," he says.
This has recently exploded into what was almost an open war between health-interest groups in the United States after a study of actual causes of death published in the Journal of the American Medical Association suggested that obesity and inactivity were about to surpass tobacco as the leading killer. Anti-tobacco activists went so far as to call on the AMA to withdraw the paper because of what they saw as a systematic bias toward exaggerating the ills of diet and lack of exercise.
Despite all of these caveats, the first figures are being compiled on how much improvements in health habits would affect the causes of death in Canada.
The initial analysis is not, as you might expect, being done by Health Canada, but at the World Health Organization in Geneva. As part of a study trying to determine what the health of the world is going to look like in 2030, it is taking raw figures supplied by this country and producing what is known as a table of "actual causes of death" -- that is, not the disease listed on your death certificate, but the upstream causes of it.
According to Australian epidemiologist Colin Mathers, who heads WHO's effort, the preliminary Canadian figures -- "I have to underscore that they are preliminary," he says -- suggest that 40 per cent of the 217,000 deaths that occurred in 2000 were preventable.
WHO's estimate is that tobacco killed 53,000 people, excess weight 17,000, inadequate consumption of fruit and vegetables 12,000, and physical inactivity 10,000.
Added to this are a considerable number of conditions that can be at least partly controlled, if not eliminated, by a combination of lifestyle changes and drugs. These include high blood pressure, which is thought to have killed 32,000 people, and high cholesterol, which killed 20,000.
So what happens if an outbreak of healthy living suddenly hits all Canadians?
The opinion is divided.
"There is very little life years to be gained," says John Frank, scientific director of the Canadian Institutes of Health Research and a professor at the University of Toronto. "We have taught this in public health for 40 years. In no countries in the world do you live past 81 or 82. What does that tell you? We are all converging on a limit, a biological limit, and we don't expect to expand it."
To underscore his argument, he says that getting rid of all cancer might bump up life expectancy by only two or three years.
On the other hand, the epidemiologists at WHO are coming up with a different and quite impressive number as they translate avoidable Canadian deaths into a longer life.
"Around about eight years would be a very rough estimate," Dr. Mathers says.
But it isn't any old eight years, but six years of good health and two years of infirmity.
This would mean that the average life expectancy in Canada would increase to 90 from about 82 for a woman and to 85 from about 77 for a man.
The context for infirmity at the end rate is a study Statistics Canada did in 2000 that calculated that every man over 65 would have 3.4 years where they would require assistance by others. For women, who generally are sicker in old age, the incapacity number is 6.5 years.
But experts point out that simply adding two years to these numbers -- likely more for women and less for men -- may not be precisely accurate because good living might diminish some of the illnesses, diabetes and heart disease among them, that currently lead to ill health at the end.
So what would we ultimately die of? "Boredom," cracks David Allison, a professor of clinical nutrition at the University of Alabama at Birmingham who has co-written a seminal paper on the years lost to obesity in the United States.
Some argue that it will be a bunch of little things that do us in. "There are a million things chasing our tail," Prof. Frank says. "Don't forget, once you are frail, the actual cause of death may be that you fell and broke your hip and never came out of it. Or you just get pneumonia after the flu. For most people after eightysomething, it doesn't take much."
A different and more fearsome vision is what some have taken to calling Ronnie's Paradox. Are we going to be faced with an avalanche of aged people who, like former U.S. president Ronald Reagan, live on and on with a failing mind because they have taken such exemplary care of their bodies when they were younger?
Neurological diseases such as Alzheimer's, Parkinson's and dementia kill 3.6 per cent of Canadian women 65 to 69 and 11.9 per cent of those over 90.
Advertisement
"There are a bunch of people who just say, gloom and doom, if we stop people dying from what they have been dying of, they're all going to have Alzheimer's disease at a later time," Dr. Mathers says about the Canadian statistics.
"The fact is that you are getting extra years of healthy life over all. So it depends on your individual values of whether you think a few years of Alzheimer's at age 90 is more than off set by 10 or so more healthy years in your 50s, 60s or 70s."
It is a trade-off that people are beginning to be asked their opinion on with some disquieting results. A recent study at the University of Pittsburgh suggested that if people were given a choice, they would trade seven months of healthy time for better treatment in the one month they were dying.
And sometimes ill health focuses the mind in ways that being healthy never did. Another study at the University of Pittsburgh suggests that people who are sick with liver failure would sacrifice more than 20 per cent of their total life to be healthy for the remaining bit.
But what does that mean for the average Canadian who has taken up the pledge of healthy living without considering the long-term consequences of their virtue?
If the people exercising relentlessly at Venus Fitness to the heavy beat of Me & My singing, "I can live, live without your love" are any indication, you live for the present and hope for the future.
In the same gym where Mr. Devine is running hard on the treadmill, a slim, fit 43-year-old Margot Brown has just finished her workout and is reflecting on the trade-offs between age and health. The management consultant announces that the reason she takes herself to the gym three to five times a week is the U.S. Army's motto, "Be the best that you can be." And she hopes that will apply to the end of her life.
"I personally am the kind of person who gets a lot of joy out of the small things. I imagine I still will be enjoying small things even when I am 90," she says brightly.
But what about the great decline? The two extra years of dependence?
"I am hoping there are enough advances in medicine and palliative care that those two years will be a blur," she says, and laughs a little at the happy bleakness of her imagery.
Stephen Strauss writes on science for The Globe and Mail.
By the numbers
Worried about your lifestyle? Consider these figures:
In 2000, WHO estimates that in Canada there were 217,000 preventable deaths.
The killers?
Tobacco: 53,000,
High blood pressure: 32,000
High cholesterol: 20,000
Excess weight: 17,000,
Inadequate consumption of fruit and vegetables: 12,000,
Physical inactivity: 10,000
[ February 27, 2005, 07:36 PM: Message edited by: Q. ]
Linear Mode
